When we think of the word violence, we tend to picture physical altercations: a slap to the face, a punch to the gut. Or perhaps we might picture something a bit less tangible — say, verbal assault or emotional abuse. At any rate, in each of these situations, the interaction is person-to-person; it is individual perpetrators inflicting harm on others. What happens, however, when the perpetrators aren’t so much distinct entities, but rather entire social systems?
Sociologists have dubbed this phenomenon structural violence, and it goes beyond the individual. The term was officially coined by Johan Galtung, sociologist, and founder of the Journal of Peace Research, in 1969; although, public health specialists had long before acknowledged the social determinants of well-being. Structural violence explains what happens when inequalities become institutionalized — think classism, racism, misogyny — and consequently bring harm to vulnerable members of the population. In the context of medical anthropology, structural violence refers specifically to the detrimental health effects brought on by such institutions. Low-income populations experiencing increased malnutrition, avoiding necessary medical care due to lack of financial means, and being subjected to poorer environmental conditions are all examples of structural violence. These inequalities are embedded in our social order (hence the “structural” aspect of the term). Although structural violence is regarded as an “invisible” force, it doesn’t take much effort to see the blatant correlation between wealth and health disparities.
Sociologists have dubbed this phenomenon structural violence, and it goes beyond the individual.
Structural violence shows us that well-being goes far beyond the biological basis of disease; the social determinants of health should be an essential component of dialogues about public health. Social forces, shaped by the political and economic climate of communities, greatly influence health outcomes for disease. By understanding the roots of disease in a biosocial context, we can better understand how to tackle treatments in a more holistic way. In a paper by Harvard medical anthropologist Paul Farmer, he explores different studies regarding structural violence and its relation to HIV/AIDS treatments. One study found that eliminating transportation costs and increasing treatment convenience significantly improved health outcomes for AIDS patients in Baltimore, Maryland. In Rwanda, Partners in Health, the nonprofit co-founded by Farmer, has worked to create a model of AIDS treatment that goes further than clinical care. Patients are accompanied by caretakers who can offer medical services and deliver drugs to their homes, allowing for an effective combination of both distal and proximal care.
On the domestic front, the issue of structural violence in healthcare is certainly a pressing issue with the presidential election on the horizon. As millions of Americans live without health insurance — and millions more go underinsured — it may be prudent to keep these large-scale social forces in mind when casting your ballot. Beyond that, though, understanding structural violence on a global scale is critical to changing our perception of healthcare in the developing world.
When we look at developing countries — countries that have been wrought by poverty, political upheaval, and the legacies of colonialism — it’s easy for many to look at them as lost causes. But it’s crucial to acknowledge the potential in other nations’ healthcare systems. Organizations like Doctors Without Borders can only do so much; simply importing first-world resources is a temporary fix to a much larger problem. Change has to occur at the governmental level to create long-term solutions. We must recognize that foreign medical systems are more than just charity cases, and health outcomes for impoverished nations can be improved, so long as there is a will to do so.
African Journal of Disability (2017). DOI: 10.4102/ajod.v6i0.274
PLoS Medical (2006). DOI: 10.1371/journal.pmed.0030449
